Transfemoral TAVR in patients with severe aortic stenosis and prior CABG was associated with a higher rate of discharge home compared to SAVR (95% vs. 73%; p=0.01) and shorter length of stay.
Cohort (n=1,059)
No
Does transfemoral TAVR improve morbidity, length of stay, and discharge location compared to SAVR in patients with severe aortic stenosis and prior CABG?
In patients with severe aortic stenosis and prior CABG, TF-TAVR is associated with lower morbidity, shorter length of stay, and higher rates of home discharge compared to SAVR.
Absolute Event Rate: 95% vs 73%
p-value: p=0.01
BackgroundPublished trials have shown that transcatheter aortic valve replacement (TAVR) is a safe alternative to surgical aortic valve replacement (SAVR) after prior coronary artery bypass grafting (CABG). However, differences in morbidity and discharge location between the 2 procedures are less thoroughly characterized.MethodsFrom January 1, 2006 to January 7, 2020, 1059 patients with severe aortic stenosis after CABG underwent either SAVR (n = 315/30%), transfemoral TAVR (TF-TAVR) (n = 575/54%), or alternative access TAVR (n = 169/16%) at a single, tertiary care, academic institution. Propensity-weighted matching was used to compare morbidity, mortality, length of postprocedure stay, and nonhome discharge between TF-TAVR (effective n = 163) and SAVR (effective n = 163) groups.ResultsAmong propensity-weighted groups, the TF-TAVR group experienced fewer transfusions than the SAVR group (effective n = 16 9.5% vs. 132 81%; p 24 hours (effective n = 0.41 0.25% vs. 30 18%; p <0.0001). Permanent pacemaker implant was 9.3% (effective n = 13) after TF-TAVR vs. 5.5% (effective n = 7.9; p = 0.2) after SAVR, stroke 0.41% (effective n = 0.67) vs. 2.1% (effective n = 3.5; p = 0.2), and operative mortality 0.5% (effective n = 0.8) vs. 1.7% (effective n = 2.8; p = 0.8). The TF-TAVR group had shorter postprocedure lengths of stay (2.0 vs. 7.6 days; p < 0.0001). Discharge home was more common after TF-TAVR than SAVR (effective n = 156 95% vs. 118 73%; p = 0.01).ConclusionsFor patients developing severe aortic stenosis after CABG, TF-TAVR rather than SAVR should be strongly considered because of lower morbidity, shorter length of stay, and greater likelihood of home discharge.
Hasan et al. (Tue,) conducted a cohort in Severe aortic stenosis after CABG (n=1,059). Transfemoral transcatheter aortic valve replacement (TF-TAVR) vs. Surgical aortic valve replacement (SAVR) was evaluated on Discharge home (p=0.01). Transfemoral TAVR in patients with severe aortic stenosis and prior CABG was associated with a higher rate of discharge home compared to SAVR (95% vs. 73%; p=0.01) and shorter length of stay.
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